Elsevier

The Journal of Pediatrics

Volume 158, Issue 6, June 2011, Pages 1009-1015.e1
The Journal of Pediatrics

Original Article
Neutrophil Gelatinase-Associated Lipocalin Concentrations Predict Development of Acute Kidney Injury in Neonates and Children after Cardiopulmonary Bypass

https://doi.org/10.1016/j.jpeds.2010.12.057Get rights and content

Objectives

To investigate neutrophil gelatinase-associated lipocalin (NGAL) as an early acute kidney injury (AKI) biomarker after neonatal and pediatric cardiopulmonary bypass (CPB).

Study design

Serum and urine samples were obtained before and at intervals after CPB from 374 patients. AKI was defined as a serum creatinine (SCr) concentration increase from baseline ≥0.3 mg/dL in neonates and ≥50% in children within 48 hours of CPB. Logistic regression was used to assess predictors and clinical outcomes associated with AKI.

Results

AKI developed in 30% of patients. Plasma and urine NGAL thresholds significantly increased in patients with AKI at 2 hours after CPB and remained elevated at all points, with 2-hour NGAL the earliest, strongest predictor of AKI. In non-neonates, 2-hour plasma and urine NGAL thresholds strongly correlated with length of hospital stay and severity and duration of AKI.

Conclusion

Plasma and urine NGAL thresholds are early predictive biomarkers for AKI and its clinical outcomes after CPB. In neonates, we recommend a 2-hour plasma NGAL threshold of 100 ng/mL and 2-hour urine NGAL threshold of 185 ng/mL for diagnosis of AKI. In non-neonates, recommended AKI thresholds are 50 ng/mL for both 2-hour plasma and urine NGAL.

Section snippets

Methods

This study was approved by the institutional review board of Cincinnati Children’s Hospital Medical Center. All patients <18 years of age undergoing cardiac surgery with CPB at our center between January 2004 and May 2007 were approached for study inclusion. Written informed consent was obtained from the legal guardian of each patient, with assent from the patient when appropriate, before enrollment. Patients with severe pre-existing renal insufficiency (SCr concentration >2 times reference

Results

Overall, 374 children were enrolled. A total of 65% of eligible patients consented to participate in the study. Demographic and clinical characteristics of enrolled patients were similar to the overall cardiac surgery population at our institution. One patient was ineligible because of severe kidney injury, and no patients were excluded because of past nephrotoxin use. One patient was subsequently excluded from analysis because the date of birth was not available. Thirty-five patients were in

Discussion

Our results confirm that plasma and urine NGAL are excellent early predictors for AKI after neonatal and pediatric CPB. In both of the age groups, urine and plasma NGAL predicted AKI within 2 hours after onset of CPB, with very high sensitivity and specificity rates. Additionally, in the non-neonatal group, NGAL was associated with AKI severity and clinical prognosis. Thus, NGAL offers a unique opportunity to dramatically affect the management of AKI by delivering diagnostic, severity, and

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    Supported by grants from the National Institutes of Health (RO1-HL08676, RO1-HL085757, RO1-DK069749) and a Translational Research Initiative Grant from Cincinnati Children’s Hospital Medical Center. P.D. is a co-inventor of patents related to neutrophil gelatinase-associated lipocalin as an acute kidney injury biomarker and is a consultant to Abbott Diagnostics and Biosite. The other authors declare no conflicts of interest.

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